Kostitska I. Diabetic gastroparesis: prevalence, risk factors, mechanisms of the development, treatment.

On the basis of complex determination of morphological, clinical, laboratory and instrumental, biochemical and immunoenzymometric parameters in patients with diabetes and the signs of slowing the gastric motor-evacuation function, theoretical generalization has been presented and a new solution for a relevant problem of modern endocrinology, namely the early diagnosis of diabetic gastroparesis (DG). Object of the research: diagnostic and treatment of different stage of DG. The objective of the study - optimization of the modern concept of diagnosis, improvement of the effect of treatment and prevention of DG based on the definition of risk factors and features of the clinical course. Methods: general clinical, clinical laboratory, biochemical, enzyme immunoassay, instrumental, histological, electron microscopic, morphometric methods of research; mathematical and statistical. Based on the obtained results, a new solution for the applied research task to find the methods of mathematical calculation as well as the prediction of DG has been proposed. The strategy, diagnostic and therapeutic measures for correcting the slowing down of the gastric motor-evacuation function as a predictor of postprandial hypoglycaemia in patients with DM have been developed. The role of peripheral myelin protein 22 (PMP22) in the pathogenesis of developing nerve fiber demyelination in patients with the signs of gastroparesis and without them has been studied for the first time ever. An elevated level of PMP22 has been proven to be an early diagnostic marker of DG. A low level of ghrelin and hypercholecystokininaemia have been found in patients with DG. The structure of the relationships between the deteriorations in carbohydrate and lipid metabolism, the degree of nerve ending demyelination in patients with DG and without them depending on the disease duration, the patients’ age and gender, the state of glycemic control, the presence of chronic complications, concomitant diseases and bad health habits has been determined. Diagnostic and therapeutic algorithms for the management of patients with DG are developed and substantiated. The results of the research were introduced into the medical practice of endocrinologists, family medicine general practitioners in medical centers of Ivano-Frankivsk, Dnipro, Lviv, Zaporizhzhia, Kharkiv, Chernivtsi, Vinnytsia, Ternopil. Theoretical principles and practical recommendations are used in the lecture course, seminars and practical classes in Ivano-Frankivsk National Medical University, Shupyk National Medical Academy of Postgraduate Education, Zaporozhye State Medical University, Danilo Galitsky Lviv National Medical University, Kharkiv Medical Academy of Postgraduate Education, National Pirogov Memorial Medical University, Bukovinian State Medical University.